Archive for June, 2011

Part of my daily battle is explaining contraceptive methods to a patient who comes in and simple says “I want to go on the ill!”

“OK dear, here we are!”…. Oh if only it was that simple.

First you have to tip toe through the mine fields of contra-indications for the various contraceptive groups: This included the medical twist on the “not tonight dear I have a headache” which is… “You have migraines…No COC for you!” If you unfamiliar with the abbreviations, all will become apparent further down!

Even if you’ve established that they may be an uncomplicated patient that can use any type of contraceptive, you then have to give the patient choices, and these have to be informed. I find I have so much information to give out and so little time in which to do it!

Ok so you’ve 10 minutes to establish any medical reasons they shouldn’t have any particular method of contraception, discuss safe sex, be satisfied they are not already pregnant having had UPSI! (I’ll give you that one now… as it is probably my favourite medical abbreviation: UPSI stands for Un-protected Sexual Intercourse. Obviously I like it because it sounds like the sort of thing a perfect gentleman would say when they realises his mistress is not “on the pill”. Oooops Daisy. I was horrified to find my daughter talking about UPSI, when she’s not even 2 yet).

The Night Garden?…Upsy Daisy? The Ninky Nonk? Sounds a bit perverse to me!

If the patient has had UPSI, then you can give them a MAP!!! (that’s the Morning after pill, and not directions on where to buy cots, and absolutely nothing to do with helping men finding the “G” spot).

…and then still in 10 minutes you have to go over the following options.

COC: That’s the Combined Oral Contraceptive. Whoever decided to think that title up should be shot. What’s wrong with calling it a CCT (Combined contraceptive tablet)? It would save patients seeing it written down and saying…”If it wasn’t for COCK I wouldn’t need a contraceptive!” This “funny” gag gets reused later in this post too!

With COC’s you have to advise the patient that it can cause:

– headaches…(more “Not tonight love, I’ve a headache” gags!);

– weight gain (but not as much as an 8lb baby);

– and increased risks of thrombosis and cervical cancer, but not much.

POP: Progesterone Only Contraceptive (and not the sound of a condom allegedly breaking). Easy peasy, less risk of complication, although if you miss one by mistake there is an increased risk of getting a parasitical infection with life altering effect. The parasite slowly increases in size, cause body swelling, nausea and after about 9 months burst out of your vagina and starts screaming at you, you then need to look after it for about 18 years, before it moves away, but still rings you asking for money and bringing it’s dirty washing to your house. Surely that would scare you enough to remember to take the pill at the same time every day! With the modern POP’s you can even be relatively late taking it and be fine.

Next we have the LARC’s: These are the Long Acting Reversible Contraceptives. They are progesterone based and can cause some people to bleed, although normally this resolves and they can stop periods for the full duration of use (and a bit afterwards). The LARC’s include:

Implant: A simple procedure where a small implant is popped into the patients arm and gives contraceptive cover for 3 years.

Both these involve needles and so give the patient an opportunity to giggle, when the clinician says “Just a small prick” and the patient retorts: “If it wasn’t for a small pricks I wouldn’t need contraceptives”. Oh hilarious …again!

Then there is the IUD – Intra- Uterine Device! An IUD is a small, T-shaped contraceptive device made from plastic and copper that fits inside the womb (uterus). The clinician inserts it via the vagina…(If it wasn’t for things going in my vagina I wouldn’t need contraceptive…oh give it a rest now, would you?)…and basically it acts as spermicidal barbed wire with a hint of chemical warfare.

Other LARC’s include actually having children, for the next 18yrs you and your partner will be too knackered for sex and on the odd occasion you can muster the energy and enthusiasm, one of you children will cry, vomit or do something else that ruins the mood.

Permanent Contraception: These include “the snip”, getting the man in the relationship so drunk and on so many promises he agrees to have a vasectomy. This contraceptive only works if the female is only having sex with the man who has had the vasectomy!!! Female sterilisation is another option, or becoming a nun, a lesbian, or just abstaining from sex, or better still a lesbian nun that’s abstaining from sex, (although I suppose there’s always the immaculate conception risk! An angel came from heaven…discusting high velocity splatter!)

…and there you have it, the most cram packed 10 minute consultation….Come on! Decide would you?!? Sadly that 10 minutes I spend talking to woman about sex, is probably longer than they’ve ever talked about sex with their partners, or even worse, longer than the act itself actually takes…surely not!